|
TRANSPLANT HAND TENDON(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
761P0708
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.75 |
| Max. Negotiated Rate |
$1,323.87 |
| Rate for Payer: Aetna Commercial |
$1,052.65
|
| Rate for Payer: Ambetter Exchange |
$679.98
|
| Rate for Payer: Anthem Medicaid |
$392.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$679.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$679.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$815.98
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$1,323.87
|
| Rate for Payer: Healthspan PPO |
$953.48
|
| Rate for Payer: Humana Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$906.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$679.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$400.41
|
| Rate for Payer: Molina Healthcare Passport |
$392.56
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$883.97
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$396.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$679.98
|
|
|
TRANSPLANT PALM TENDON
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 26485
|
| Hospital Charge Code |
360P1267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,413.52 |
| Rate for Payer: Aetna Commercial |
$1,142.15
|
| Rate for Payer: Ambetter Exchange |
$774.05
|
| Rate for Payer: Anthem Medicaid |
$414.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$774.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$774.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$928.86
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,413.52
|
| Rate for Payer: Healthspan PPO |
$1,034.55
|
| Rate for Payer: Humana Medicaid |
$414.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$774.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$774.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.49
|
| Rate for Payer: Molina Healthcare Passport |
$414.21
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,006.26
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$774.05
|
|
|
TRANSPLANT PALM TENDON
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 26485
|
| Hospital Charge Code |
36001267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,413.52 |
| Rate for Payer: Aetna Commercial |
$1,142.15
|
| Rate for Payer: Ambetter Exchange |
$774.05
|
| Rate for Payer: Anthem Medicaid |
$414.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$774.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$774.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$928.86
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,413.52
|
| Rate for Payer: Healthspan PPO |
$1,034.55
|
| Rate for Payer: Humana Medicaid |
$414.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$774.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$774.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.49
|
| Rate for Payer: Molina Healthcare Passport |
$414.21
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,006.26
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$774.05
|
|
|
TRANS,RADIAL BRACHIAL ARTERY
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$354.22 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.70
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
TRANS,RADIAL BRACHIAL ARTERY
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$721.00 |
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
|
|
TRANS,RADIAL BRACHIAL ARTERY
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.00 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$710.70
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
TRANSTHOR CATH FOR STENT
|
Facility
|
OP
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
76101315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.99 |
| Max. Negotiated Rate |
$1,033.56 |
| Rate for Payer: Aetna Commercial |
$829.00
|
| Rate for Payer: Anthem Medicaid |
$370.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$893.59
|
| Rate for Payer: First Health Commercial |
$1,022.79
|
| Rate for Payer: Humana Commercial |
$915.13
|
| Rate for Payer: Humana KY Medicaid |
$370.25
|
| Rate for Payer: Kentucky WC Medicaid |
$374.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$882.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.43
|
| Rate for Payer: Ohio Health Group HMO |
$807.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$742.87
|
| Rate for Payer: PHCS Commercial |
$1,033.56
|
| Rate for Payer: United Healthcare All Payer |
$947.43
|
|
|
TRANSTHOR CATH FOR STENT
|
Facility
|
IP
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
76101315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.99 |
| Max. Negotiated Rate |
$1,033.56 |
| Rate for Payer: Aetna Commercial |
$829.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$893.59
|
| Rate for Payer: First Health Commercial |
$1,022.79
|
| Rate for Payer: Humana Commercial |
$915.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$882.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.43
|
| Rate for Payer: Ohio Health Group HMO |
$807.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$742.87
|
| Rate for Payer: PHCS Commercial |
$1,033.56
|
| Rate for Payer: United Healthcare All Payer |
$947.43
|
|
|
TRANSTHOR CATH FOR STENT
|
Professional
|
Both
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
76101315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.82 |
| Max. Negotiated Rate |
$1,712.89 |
| Rate for Payer: Aetna Commercial |
$1,639.44
|
| Rate for Payer: Ambetter Exchange |
$875.18
|
| Rate for Payer: Anthem Medicaid |
$810.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$875.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,050.22
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$1,712.89
|
| Rate for Payer: Healthspan PPO |
$1,208.68
|
| Rate for Payer: Humana Medicaid |
$810.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,250.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$875.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$875.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$827.10
|
| Rate for Payer: Molina Healthcare Passport |
$810.88
|
| Rate for Payer: Multiplan PHCS |
$645.97
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,137.73
|
| Rate for Payer: UHCCP Medicaid |
$376.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$875.18
|
|
|
TRANSTHOR CATH FOR STENT(P
|
Professional
|
Both
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
761P1315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.82 |
| Max. Negotiated Rate |
$1,712.89 |
| Rate for Payer: Aetna Commercial |
$1,639.44
|
| Rate for Payer: Ambetter Exchange |
$875.18
|
| Rate for Payer: Anthem Medicaid |
$810.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$875.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$875.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,050.22
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$1,712.89
|
| Rate for Payer: Healthspan PPO |
$1,208.68
|
| Rate for Payer: Humana Medicaid |
$810.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,250.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$875.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$875.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$827.10
|
| Rate for Payer: Molina Healthcare Passport |
$810.88
|
| Rate for Payer: Multiplan PHCS |
$645.97
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,137.73
|
| Rate for Payer: UHCCP Medicaid |
$376.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$875.18
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
76101775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
76101775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$2,200.98 |
| Rate for Payer: Aetna Commercial |
$2,113.55
|
| Rate for Payer: Ambetter Exchange |
$1,170.20
|
| Rate for Payer: Anthem Medicaid |
$1,133.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,170.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,404.24
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,200.98
|
| Rate for Payer: Healthspan PPO |
$1,337.04
|
| Rate for Payer: Humana Medicaid |
$1,133.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,685.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,170.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,156.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,133.99
|
| Rate for Payer: Multiplan PHCS |
$1,875.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,521.26
|
| Rate for Payer: UHCCP Medicaid |
$1,093.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,145.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,170.20
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
76101775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
TRANSTHOR DIAPHRAG HERN RPR(P
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
761P1775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$2,200.98 |
| Rate for Payer: Aetna Commercial |
$2,113.55
|
| Rate for Payer: Ambetter Exchange |
$1,170.20
|
| Rate for Payer: Anthem Medicaid |
$1,133.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,170.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,170.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,404.24
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,200.98
|
| Rate for Payer: Healthspan PPO |
$1,337.04
|
| Rate for Payer: Humana Medicaid |
$1,133.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,685.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,170.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,156.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,133.99
|
| Rate for Payer: Multiplan PHCS |
$1,875.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,521.26
|
| Rate for Payer: UHCCP Medicaid |
$1,093.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,145.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,170.20
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$6,576.02
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,697.16 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,461.49
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,186.78 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
|
|
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$4,461.49
|
|
|
Service Code
|
CPT 52640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,186.78 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
|
|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$6,576.02
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,697.16 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
|
|
TRANSURETHRAL WATERJET ABLATION OF PROSTATE, INCLUDING CONTROL OF POST-OPERATIVE BLEEDING, INCLUDING ULTRASOUND GUIDANCE, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED WHEN PERFORMED)
|
Facility
|
OP
|
$11,961.85
|
|
|
Service Code
|
CPT 0421T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,544.18 |
| Max. Negotiated Rate |
$11,961.85 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,544.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,961.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,534.64
|
| Rate for Payer: Humana Medicare Advantage |
$8,544.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,253.02
|
|
|
TRANSVAGINAL ULTRASOUND
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$354.00 |
| Max. Negotiated Rate |
$1,132.80 |
| Rate for Payer: Aetna Commercial |
$908.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$920.40
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$979.40
|
| Rate for Payer: First Health Commercial |
$1,121.00
|
| Rate for Payer: Humana Commercial |
$1,003.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$967.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$870.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,038.40
|
| Rate for Payer: Ohio Health Group HMO |
$885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,026.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$814.20
|
| Rate for Payer: PHCS Commercial |
$1,132.80
|
| Rate for Payer: United Healthcare All Payer |
$1,038.40
|
|
|
TRANSVAGINAL ULTRASOUND
|
Professional
|
Both
|
$1,180.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna Commercial |
$182.35
|
| Rate for Payer: Ambetter Exchange |
$106.20
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.44
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$156.03
|
| Rate for Payer: Healthspan PPO |
$170.87
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$708.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$138.06
|
| Rate for Payer: UHCCP Medicaid |
$413.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.20
|
|
|
TRANSVAGINAL ULTRASOUND
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
40200044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,132.80 |
| Rate for Payer: Aetna Commercial |
$908.60
|
| Rate for Payer: Anthem Medicaid |
$405.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$920.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cash Price |
$590.00
|
| Rate for Payer: Cigna Commercial |
$979.40
|
| Rate for Payer: First Health Commercial |
$1,121.00
|
| Rate for Payer: Humana Commercial |
$1,003.00
|
| Rate for Payer: Humana KY Medicaid |
$405.80
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$409.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$967.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$870.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,038.40
|
| Rate for Payer: Ohio Health Group HMO |
$885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,026.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$814.20
|
| Rate for Payer: PHCS Commercial |
$1,132.80
|
| Rate for Payer: United Healthcare All Payer |
$1,038.40
|
|
|
TRANSVAGINAL ULTRASOUND(P
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
402P0044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$182.35 |
| Rate for Payer: Aetna Commercial |
$182.35
|
| Rate for Payer: Ambetter Exchange |
$106.20
|
| Rate for Payer: Anthem Medicaid |
$71.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$106.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$106.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.44
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cash Price |
$77.50
|
| Rate for Payer: Cigna Commercial |
$156.03
|
| Rate for Payer: Healthspan PPO |
$170.87
|
| Rate for Payer: Humana Medicaid |
$71.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$106.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.80
|
| Rate for Payer: Molina Healthcare Passport |
$71.37
|
| Rate for Payer: Multiplan PHCS |
$93.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$138.06
|
| Rate for Payer: UHCCP Medicaid |
$54.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$72.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$106.20
|
|
|
TRANSVAGINAL ULTRASOUND(T
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
402T0044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
TRANSVAGINAL ULTRASOUND(T
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 76830
|
| Hospital Charge Code |
402T0044
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
